Proprioception- That’s Physical Therapy

Proprioception-A word that you may want to understand better as it relates to your body is “proprioception”. It’s a term that is important to all human movement, athletic performance, injury prevention, and rehabilitation.

Proprioception [pro”pre-o-sep’shun]
“A sense or perception, usually at a subconscious level, of the movements and position of the body and especially its limbs, independent of vision; this sense is gained primarily from input from sensory nerve terminals in muscles and tendons (muscle spindles) and the fibrous capusle of joints combine with input from the vestibular apparatus.” (Farlex Partner Medical Dictionary)

“The internal sense of the relative position of the body’s musculoskeletal units with each other and the effort needed to move them.” (Segan’s Medical Dictionary)

Proprioception (PRO-pree-o-SEP-shən) is the sense of the relative position of neighboring parts of the body and strength of effort being employed in movement.[3]
In humans, it is provided by proprioceptors (muscle spindles) in skeletal striated muscles and tendons (Golgi tendon organ) and the fibrous capsules in joints.
The brain integrates information from proprioception and from the vestibular system into its overall sense of body position, movement, and acceleration.

Wow, that seems like a lot of medical mumbo-jumbo to simply say that our bodies have an amazingly integrated capacity to process the positions of the body and conduct human motion! Interesting that the definition of “proprioception” includes mention of multiple systems within the body: muscular, joint, vestibular and nervous systems. All of these things provide information and data to the brain which amazingly filters it all to provide us with our sense of body position and movement.

Proprioception is a subconscious process. As described above, receptors in our muscle, ligament and joint tissues send ongoing information to the brain. When this process is going well we really don’t have any awareness of all that ongoing activity. It’s like driving your car in busy traffic just expecting all mechanical and electrical circuits are processing data and making constant adjustments as designed.

However, when these tiny nerve signals are altered for one reason or another it can cause problems with both simple daily tasks (posture awareness, walking, navigating stairs) and complex activities (sports, walking on unstable surfaces, combined movements of trunk and limbs). This can lead to falls, a traumatic injury to an unstable joint (ACL tear for example), or simply decreased activity by a person that senses they are “off” and at risk.
As a physical therapist, proprioception is a big big deal, as it directly relates to our potential success in helping essentially every patient we see reach their goals. Yes, I said essentially EVERY patient. You might ask; how is that and can you provide some examples? Yes.

My 35 year old patient who fractured his ankle playing what he calls ‘old man softball’ has been in a cast for 6 weeks. Doc says the bone is healed. Good to go, just ease back into activities, right? Not so fast. This guy needs to recover his joint range of motion and his muscle strength, but most importantly he needs to restore proprioception. He needs to reset, or reprogram some of those unconscious systems that have been taken away by immobilization and walking like a pirate with a peg-leg for 6 weeks. That’s physical therapy.
My 5 year old patient is a “toe walker”. Mom and dad say he’s walked that way since he graduated from crawling. He doesn’t just need stretches to loosen up his calves, he needs help reprocessing how to stand and walk with new feedback occurring from his joints, tendons, and ligaments while his feet are mostly flat on the ground! That’s physical therapy.

My 61 year old patient just had a total hip replacement after nearly 3 years of progressive hip pain, difficulty walking, and several unfortunate falls. Surgery was a complete success with relief of the daily hip pain, but she had not recovered her sense of balance and had a feeling that would limit her more than anything returning to activities. She was actually relieved to hear that the soft tissues (muscle, ligament, tendon) around the hip joint are the body’s number one area for acquiring proprioception for balance, and that we could help her retrain this process now that arthritic pain was no longer scrambling the signals that her brain was receiving. That’s physical therapy.

My 84 year old patient, a widower, desires more than anything to continue living in the home she shared for more than 50 years with her husband. But as she has gotten more sedentary her family and doctor notice that her balance and walking gait are ‘off’, and she’s at risk for a fall. There’s talk she may need to go to an assisted living facility. Her proprioception systems aren’t being challenged, and well, they’ve gone on vacation. Can we develop some safe, simple and even fun exercises for her to do daily that will improve her proprioception and overall balance? She doesn’t care what we call it, she just wants to be stable enough to continue living at home. That’s physical therapy.

My 16 year old phenom soccer player has already verbally committed to play for a D-1 school on athletic scholarship, but tore her ACL and has undergone reconstructive surgery. The surgery itself was a success, but now we need to recover knee range of motion, strength through her entire leg and core, and most importantly her ability to sense where her body is in space. Her internal proprioceptive systems must process correctly and tell her where her center of mass is relative to her injured leg so that she is functional stable. But more important to her we need this so she can move again with the speed and control that made her an elite athlete. That’s proprioception, and that’s physical therapy.
Proprioception: an individual’s sense of the relative position of the various parts of the body and the strength and effort being used in movement.
A pretty incredible design our body has.